Bringing AIDS therapies, vaccine trials to the poorest nation in the Western Hemisphere

Editor’s Note: This story, first published in 2004, has been
updated.

Bill Snyder
Published: April, 2004

Young people congregate in front of the graffiti-splashed wall of the GHESKIO center across the street from one of the poorest slums in Port-au-Prince, Haiti.

Photography by Jonathan Rodgers

Across Harry Truman
Boulevard from one of the poorest slums in Port-au-Prince, a corps of dedicated health care professionals is slowly, stubbornly mastering one of the worst
scourges in the history of humankind.

Beset by frequent political turmoil, Haiti is the poorest nation in the Western Hemisphere. It also has the
highest rate of HIV infection on this side of the globe. Yet Haiti’s AIDS burden has never come close to the levels seen in some West African nations, and
it seems to be declining.

“To me this is the most amazing thing. If you can do it here in this chaos, we know it can be done everywhere,”
says pioneering Haitian physician Jean Pape, founder and director of the GHESKIO centers, the oldest AIDS research organization in the developing
world.

By documenting HIV-tainted blood transfusions, GHESKIO convinced the Haitian Ministry of Health—its constant partner and
supporter—to replace commercial blood banks with Red Cross blood centers. Encouraged by public education campaigns, condom sales have risen, and the HIV
infection rate has been cut in half—to about 3 percent—since the mid-1980s.

GHESKIO is an acronym that—in French—stands for
the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections. Since it was established in 1982, GHESKIO has received support from the National
Institutes of Health and assistance from New York’s Weill Cornell Medical College, where Pape is professor of International Medicine and Infectious
Diseases.

In the early 1990s, GHESKIO began a new relationship with Peter Wright, M.D., former chief of the Pediatric Infectious Diseases Division at
Vanderbilt University Medical Center. Cornell and Vanderbilt provide medical expertise and help train Haitian physicians, and young U.S. physicians gain
experience at GHESKIO treating HIV and other illnesses.

GHESKIO logs more than 100,000 patient visits a year for free testing, counseling and
treatment. Thanks to lower-cost generic drugs, it was able to provide combination anti-retroviral therapy for the first time last year. So far, 1,000 patients
have been treated. That’s a drop in the bucket compared to the estimated 400,000 people who are infected in this Caribbean nation of 8
million.

GHESKIO patient Edner Hyppolite raises his arms in thanks for the medication he is receiving to control his HIV infection.

Photography by Jonathan Rodgers

“Now the challenge is how to implement anti-retroviral therapy across the country, when the health infrastructure is very poor and
sometimes very unreliable,” says Vladimir Berthaud, M.D., MPH, a native Haitian who teaches at Meharry Medical College in Nashville, Tenn. “There
are a lot of logistical problems. But it’s not impossible at all.”

Toward that end, Berthaud and his physician colleagues at
Vanderbilt—David Haas, M.D., and Catherine McGowan, M.D.—are helping to establish an International AIDS Clinical Trial Unit in Port-au-Prince.
“You have to be able to measure what you’re doing,” Wright explains. “Without a lot of training of physicians and education of the
people, it won’t make sense to just spread out some anti-retroviral drugs.”

Over the years, GHESKIO has fostered a strong sense of trust
and loyalty among Port-au-Prince residents, many of whom live in tin-roofed shacks without plumbing or electricity. GHESKIO patients are enrolling in clinical
trials, and healthy subjects are signing up for tests of a candidate HIV vaccine.

Continued support from the United States is crucial, Pape says.
Added GHESKIO patient Nicole Marcelin in 2004: “Remember what is on the dollar bill—‘In God We Trust.’ It means (Americans)… will
help people who are living with the virus. When they help them, they also help themselves.”